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Opinion

Covid-19 in Afghanistan: Exposing weaknesses in healthcare system

Afghan healthcare

By: Dr. Mohammad Azeem Zmarial Kakar

The drumbeat of coronavirus warnings caused panic among the health authorities in Afghanistan and urged them to act impulsively to contain the coronavirus outbreak in the country. The first case of coronavirus in Afghanistan was confirmed on February 24, 2020, and the patient had a travel history to Iran – a country that has been the worst affected country in the region. Following that, the health ministry announced that the novel strain of coronavirus will infect 16 million Afghans, and 0.7 million will require hospitalization. Among them, 210,000 patients are expected to undergo treatment in critical care unit, and 110,000 is the estimated casualty rate. The announcement by health ministry triggered widespread fear among the people, and meanwhile resulting in individuals questioning the capacity of the under-funded healthcare system to handle all those estimated cases. Currently, there are 484 cases of COVID-19 in Afghanistan, and more than 50% of the cases are in Herat province, bordering with Iran. Now the question is how prepared is the healthcare system to handle the public health emergencies?

Despite the multi-billion USD investment in the healthcare sector in Afghanistan in last two decades, Afghanistan’s health system remains one of the weakest health systems in the region. Afghanistan’s Global Health Security (GHS) Index is 32.2 suggesting that the country’s health system is least prepared to handle any potential outbreak crises like COVID-19. Lack of contingency plan for outbreaks, limited ability of health system for early detection, lack of emergency preparedness and response are some of the health system gaps in beating coronavirus in the country. Additionally, health sector gains in Afghanistan is evolving slowly compared to amount of money spent on the healthcare system of the country. The most recent data from the World Bank suggests that there are three doctors per 10,000 population, five beds in hospitals are available for 10,000 patients, and only three nurses are available per 10,000 people in the country. If the estimates provided by Ministry of Public Health (MoPH) turns half-true, the healthcare system of Afghanistan is faced with a catastrophic challenge and face a collapse.

Looking at the current trends, Afghanistan’s health system lag behind performing sufficient number of COVID-19 diagnostic tests. The Ministry of Public Health (MoPH) established merely five testing facilities with the support of World Health Organization in five provinces of Afghanistan. For some provinces like Ghor and Daikundi that most of their residents have frequent travels to Iran due to shared religious and cultural ties have to wait for at least three days to receive their test result from the central laboratory located in Kabul. Moreover, some other provinces like Helmand and Urozgan has tested less than 40 cases in cumulatively. Evidence indicates that testing for COVID-19 plays a pivotal role in containing the spread of the virus. One of the successful means to contain the coronavirus in South Korea was performing more than 20,000 tests for early detection of the COVID-19 patients. On the contrary, Afghanistan has tested around 3241 samples for coronavirus as of April 9, 2020.  Lack of sufficient testing facilities in the country limits the efforts of early detection of COVID-19 and facilitates the transmission of the virus in the country.

Availability of healthcare facilities and equipment are also vital for healthcare systems to beat the coronavirus pandemic. In contrast to other countries that took a swift action to transform stadiums, schools, institutions into quarantine zones and isolation facilities for COVID-19 patients, Afghanistan decided to invest on building new infrastructures to accommodate COVID-19 patients and recruit new staff for treating COVID-19 patients in some of the provinces. Major concerns exist around the equipment required for critical patients suffering from COVID-19 complications. There are limited ventilators available at hospitals in Afghanistan. Herat province, which is at the center of the epidemic with 257 reported cases, has less than 10 ventilators. Ventilators are critical assets in treating complicated COVID-19 patients following the lung failure. In addition, Kandahar province has the third highest number of COVID-19 patients in the country, has only one functional ventilator spared for patients diagnosed with other underlying causes.

Furthermore, the capacity of healthcare professionals for treating COVID-19 patients and operating ventilators also remain a serious challenge in beating the COVID-19 crisis in Afghanistan. Only limited number of doctors and healthcare workers are available to treat patients and operate ventilators in hospitals. In some provinces, limited efforts are centered to equip the healthcare professionals and physicians with skills to sufficiently handle with critical COVID-19 patients in hospitals.

Higher number of coronavirus cases in first-line healthcare providers also highlights ineffective measures by health system to minimize the risk of COVID-19 in healthcare providers. Healthcare providers still do not have access to adequate protection against coronavirus. Current data from the country shows that coronavirus cases are higher in healthcare professions even they are not directly involved in treating COVID-19 patients. Failing to address this issue by MoPH and failing to provide Personal Protective Equipment like gloves and masks will have a serious effect on healthcare system in Afghanistan.

Even though, the COVID-19 outbreak highlights deficiencies in health system’s approach to handle the outbreak in the country, it also provides an extraordinary opportunity to enhance the capabilities of public health and the fragile health system to respond to the health emergencies. Following the COVID-19 outbreak, United States and international organizations including World Bank and Word Health Organization pledged to provide financial and technical support to Afghanistan. The support should be used effectively and wisely for preparedness of healthcare system of the country. Afghanistan should seize this once-in-a-decade opportunity by strengthening its health system through enhancing the capacity of healthcare personnel, enhance adequate surveillance, improve detection systems, and develop a comprehensive contingency plan for a rapid response to outbreaks.

Author is a Fulbright Alumnus. Dr. Zmarial Kakar has obtained his Master’s degree in Public Health from the University of Missouri-Columbia, USA. He has a second master’s degree in Public Health focusing on Comparative Effectiveness Research from the University of Paris-Descartes, France. 
 

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